The aim of this article is to give an overview of an approach to cancer patients in the covid-19 pandemic. The treatment recommendations are prioritized as per the risk stratification till the current crisis is mitigated. Measures like telemedicine/telecommunication, triage system, proved to be very effective in prevention of covid contact of cancer patients. Guidelines and protocols are needed that can decrease the risks in cancer management in such pandemic times. Multi-disciplinary work and effective communication between oncology team, critical care and emergency units is the key to optimizing clinical care of cancer patients.
Objectives To study the epidemiology and treatment outcome of glioblastoma multiforme in a tertiary care hospital. Materials and Methods This was a retrospective study performed in the Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, India, in which clinical and epidemiological details of the 80 cases diagnosed with glioblastoma multiforme from January 2016 to December 2020 were analyzed. Results The majority of the patients in our study were males, compared to females (n = 57, 23: 71%, 29%). Neurodeficiency and headache were the most common presenting symptoms. All patients were subjected to surgery followed by chemoradiation, and the overall median survival was 13 months. Conclusion Multimodality therapy, including safe, optimal surgical resection combined with adjuvant radiotherapy or concurrent chemoradiation and sequential chemotherapy, is recommended for all patients with this fatal neoplasm.
Esophageal cancer (EC) is a common cancer with high mortality because of its rapid progression and poor prognosis. One of the most successful therapies for EC is radiotherapy. Two recently created radiation methods are intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT). In terms of target coverage, dose homogeneity, and lowering toxicity to healthy organs, IMRT is thought to be superior to 3D-CRT. These benefits haven't been proven in the treatment of EC, though. This study was performed to investigate if intensity modulated radiation therapy (IMRT) offers a better planning target volume (PTV) coverage and/or lower dose to organs at risk in comparison to three-dimensional conformal radiation therapy (3DCRT). 30 patients with locally advanced histo-pathologically proven mid and lower oesophageal carcinoma, not reaching gastro-esophageal junction were treated with chemoradiation using IMRT technique. 3DCRT plans were generated for those 30 patients. The IMRT and 3DCRT plans were compared in terms of PTV coverage and doses to organs at risk. Our results revealed that IMRT is better than 3DCRT comparing PTV coverage and doses to organs at risk having statistically significant difference between both techniques (p<0.001). As for the organs at risk (OAR), the V20 for the IMRT plans delivered lesser lung volume irradiation also the mean dose to the heart and the V30 were both higher in the 3DCRT plans.Keywords: esophageal cancers (ECs), Organs at risk (OAR), Intensity modulated radiation therapy (IMRT), Three-dimensional conformal radiation therapy (3DCRT), Planned target volume (PTV).
Background: Cancer of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic disease with no identified primary. CUP has been reported to comprise approximately 2% to 5% of all cancer cases. With the availability of sophisticated imaging techniques and targeted therapies in the treatment of cancer, the extent of workup in CUP remains a challenge and should be based on the clinical presentation, radiological imaging, tumour biomarkers, pathology with immunhistochemistry and the patient’s ability to tolerate therapy. Objectives: To study the incidence, clinical presentation, histology, treatment modalities used, survival and lacunae in not establishing the diagnosis of primary.Materials & Methods: This was a retroprospective study done between January 2014 to December 2018. 650 patients of cancer of unknown primary at presentation were enrolled in this study. After going through various investigations, primary of 387 patients were detected & hence, were excluded from this study. Primary could not be detected in 263 patients even after going through comprehensive work up and henceforth, these were taken up for this study. Demographics, imaging, pathology and treatment data were analyzed from the case records retrospectively between 1st January 2014 to June 2017. The data was collected prospectively between July 2017 to December 2018. Patients with histopathological evidence of metastatic lesion were included and patients whose primary were detected after comprehensive work-up were excluded from this study. Results: Incidence of unknown primary was 0.65 per 1 lakh population. Majority of the patients were from rural areas (77.9%) & most of the patients were in the age group of 61-80 years (47.1%). Male to female ratio was 1.45:1. Abdominal pain (29.7%) and bone pain (20.5%) were the most common clinical symptoms reported. Computed Tomography & PET-CT scans detected primary lesions in 156 out of 650 (24%) & 12 out of 33 (33.3%) patients respectively. Adenocarcinoma was the most common histology (58.6%). The most common treatment modality received by the patients was external beam radiotherapy (12.5%). The median survival of the studied patients was 6-12 months. Conclusion: Patients presenting with metastatic carcinoma with unknown primary have poor outcomes. These patients need a patientcentred, streamlined, rapid diagnostic pathway. The outcome of these patients with standard chemotherapy remains poor. Larger studies with other therapeutic and novel agents are warranted to improve the treatment outcomes.
Purpose: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. Materials and Methods: 30 post-MRM female breast cancer patients with histologically confirmed infiltrating ductal carcinoma of unilateral left breast without evidence of distant metastasis or second malignancy were found eligible during January 2017 to December 2021. All patients received 45 Gy in 20 fractions. Planning target volume (PTV) parameters -D2, D98, Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 49 Gy (V49) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 42 Gy (V42) were extracted from dose-volume histograms and compared. Results: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.118 vs. 1.224, p < 0.04) but HI was similar (0.0951 vs. 0.0962, p = 0.125) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 24.52% vs. 29.62%; V49, 3.56% vs. 6.42%; p < 0.001) and heart (V25, 5.89% vs. 8.24%; V42, 1.64% vs. 6.12%; p < 0.001); mean dose of lung and heart (10.21 vs. 11.96 Gy and 3.86 vs. 7.42 Gy, respectively; p < 0.001).Conclusions: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.
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